The pathomechanics of compression injuries in the cervical spine. Nondestructive and destructive investigative methods

Biomechanical analysis using nondestructive and destructive investigative methods was performed to evaluate the mechanisms of cervical compression injuries. These injuries produce two basic modes of failure: 1) anterior dislocation; and 2) rupture of the anterior ligamentous complex of the vertebral body. Distribution of these two failure patterns was determined by the initial cervical spine position; translational alignment did not have a significant effect. Different results were observed between spines positioned in flexion and extension, indicating that the most important factor determining the mode of failure was rotational alignment in the sagittal plane.     

Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients

OBJECTIVE: To analyse the outcome of preoperative biliary drainage in patients being operated on for a tumour in the pancreatic head. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: Consecutive series of 241 patients. MAIN OUTCOME MEASURES: Decline in bilirubin concentrations and bacterial contamination of bile as a result of preoperative drainage. Incidence of postoperative complications in patients who underwent preoperative drainage and those who did not. RESULTS: 184/241 patients underwent preoperative biliary drainage. Endoscopic drainage was the most effective, shown by a median reduction in bilirubin concentrations of 82%, 74%, and 50% after endoscopic drainage (n = 149), papillotomy (n = 25) and external drainage (n = 10), respectively. Bacterial contamination of bile was significantly more common when an endoprosthesis was used, but did not result in a higher rate of infective complications. 163 Whipple's resections, 33 total pancreatectomies, and 45 biliary-enteric bypasses were performed. 137/241 (57%) patients had postoperative complications. There was no significant difference in the incidence of postoperative complications between patients who had preoperative biliary drainage and those who did not (p = 0.4).     

Practice trends of American urologists in the treatment of impotence, incontinence and infertility

PURPOSE: Trends of urologist practice patterns in evaluating and treating impotence, incontinence and infertility in the United States were assessed. MATERIALS AND METHODS: In July 1995 the executive interviewing branch of the Gallup Organization selected randomly and interviewed by telephone 533 practicing urologists in the United States who had provided urological patient care for more than 20 hours per week, practiced in 1994 and completed a urological residency program. RESULTS: Treatment of male sexual dysfunction and female urinary incontinence comprises a significant portion of the professional activity of United States urologists. However, evaluation and management of male infertility occupy a small portion of the average urological work load. While more than half of United States urologist office clinical laboratories were inspected in 1994, only 2% failed evaluation due to major deficiencies. CONCLUSIONS: Male sexual dysfunction and female urinary incontinence are major areas of urological practice in the United States but male infertility is not. Few United States urologist clinical laboratories failed inspection because of major deficiencies.     

Semi-empirical simulation of Zn/Cd binding site preference in the metal binding domains of mammalian metallothionein

Metallothionein, a two-domain protein, naturally binds seven gram atoms of divalent ions such as Zn and Cd. Four of the metals (M1, M5, M6 and M7) are found in the alpha-domain and three (M2, M3 and M4) in the beta-domain. Previous studies have shown that metals in the beta-domain are more readily exchangeable, and the level of avidity is site specific. By semi-empirical MNDO modified neglect of diatomic overlap calculations, we found the tendency of binding energy for Cd to be M4 > M2 > M3 [corrected] in the beta-cluster and M5 > M7 > M1, M6 in the alpha-cluster. Thus, the replacement of Zn by Cd can be expected to follow the order M4-->M2-->M3 in the beta-domain and M5-->M7-->M1 or M6 in the alpha-domain. This is reflected by energy differences computed with a series of simulated structures derived from either X-ray crystallography or NMR coordinates.